HEALTH CARE PRECAUTIONS DEALING
MULTIDRUG RESISTANT INFECTED
PATIENTS
Dr.T.V.Rao MD
DR.T.V.RAO MD
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MULTIDRUG-RESISTANT ORGANISMS
(MDROS)
• MDROs are defined as microorganisms –
predominantly bacteria – that are resistant to one or
more classes of antimicrobial agents. Although the
names of certain MDROs suggest resistance to only
one agent (e.g., methicillin-resistant
Staphylococcus aureus [MRSA], vancomycin
resistant enterococcus [VRE]), Extended spectrum
Betalactamse, carbapenemases resistant bacteria,
these pathogens are usually resistant to all but a few
available antimicrobial agents.
DR.T.V.RAO MD
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IMPORTANT MRDO,S IN HOSPITAL
PRACTICE
• Streptococcus pneumonia (MDRSP) which is
resistant to penicillin and other broad-spectrum
agents such as macrolides and
fluoroquinolones, multidrug-resistant gramnegative bacilli (MDR- GNB), especially those
producing extended spectrum beta-lactamases
(ESBLs); and strains of S. aureus that are
intermediate or resistant to vancomycin (i.e.,
VISA and VRSA)
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WHY MULTIDRUG RESISTANT BACTERIA ARE
IMPORTANT
MDROs that are
considered to be
epidemiologically
important and
deserve special
attention in
healthcare facilities
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TRANSMISSION OF MDRO’S
• MDROs are transmitted by
the same routes as
antimicrobial susceptible
infectious agents. Patientto-patient transmission in
healthcare settings, usually
via hands of HCWs, has
been a major factor
accounting for the increase
in MDRO incidence and
prevalence, especially for
MRSA and VRE in acute
care facilities
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PATIENT ISOLATION PRECAUTIONS FOR
HOSPITALS• Multidrug-resistant
organisms
(MDRO’s)may require
more stringent
protection, such as
methicillin resistant
Staphylococcus aureus
(MRSA).ESBL (
Extended spectrum Beta
lactamases, Multidrug
drug resistant bacteria
and Pan resistant
bacterial pathogens
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PATIENT ISOLATION PRECAUTIONS FOR
HOSPITALS• Standard Precautions (Basic level)
• Are used for care of ALL patients in a hospital all of the time
regardless of diagnosis or infection status
• Combine the major features of universal, and body
substance precautions, terms formerly used
• Applied to blood, body fluids, excretions and secretions
regardless of whether they contain visible blood, mucous
membranes and non-intact skin
• All other transmission-based precautions include (are in addition
to) Standard Precautions
• Level of use depends on anticipated contact with patient
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Isolation Precautions
Hand hygiene
Patient
placement
Patient
Transport
Isolation
Precautions
Linen & laundry
DR.T.V.RAO MD
PPE
Decontamination
Waste Management
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PATIENT ISOLATION PRECAUTIONS FOR
HOSPITALS• Other Transmission-Based Precautions Commonly Used in
Hospitals Consist of:
• Direct and Indirect Contact Precautions
• Airborne Precautions
• Droplet Precautions
• These may be used in combinations depending on whether
the microorganisms and infection in question have multiple
routes of transmission with barrier nursing.
• Special adaptations may be needed for multidrug resistant
organisms and Category A agents of bioterrorism.
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NURSING EDUCATION IS MOST IMPORTANT
TOOL IN CONTROLLING INFECTION
• Unit staff should be
educated and updated
frequently as to
appropriate infection
control for patients on
their unit.
• If possible, dedicate
same patient care staff
to care of infected
patient(s) during their
stay.
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GENERAL MEASURES
• The general hospital
environment and
"permanent" equipment
need to be protected
• Appropriate sharp/needle
precautions should be
followed as should proper
disposal of clinical waste
and laundry
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PATIENT ISOLATION PRECAUTIONS
STANDARD PRECAUTIONS
• Hand hygiene after patient contact
• Wear clean, non-sterile protective gloves when touching
blood, body fluids, secretions, excretions and
contaminated items
• Wear mask, eye protection or facial shield and gown
during procedures likely to generate splashes or spray of
blood, body fluids, secretions or excretions. Use depends
on anticipated exposure and safe injection practices as
well
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CONTACT PRECAUTIONS
CONSISTS OF STANDARD PRECAUTIONS
• Intended to prevent spread of microorganisms
from an infected patient through direct means
(touching the patient) and indirect means
(touching surfaces or objects that have been in
contact with the patient). These objects include
chairs, bedrails, telephones, IV pumps, light
switches and so on.
• Placing the patient in a private room is
preferred or when not available, it is
recommended that a set of principles be
followed such as cohorting with someone
with the same infection.
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EXTENDED STANDARD PRECAUTIONS
• Three new elements
have been added to
standard precautions.
These are:
• Respiratory
hygiene/cough etiquette
• Safe injection practices
• Use of masks for
insertion of catheters or
injection into spinal or
epidural areas
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CONTACT PRECAUTIONS
• Leak resistant bag for linens should be at
bedside.
• Dedicated thermometer, B/P apparatus and
stethoscopes are preferred unless unavoidable
and then must be cleaned and completely
disinfected before using with other patient.
• Indirect contact transmission can occur when a
susceptible patient is in contact with an
intermediate inanimate object in the patient’s
environment.
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HANDWASHING AND HAND HYGIENE
One of the most
important ways to
protect against
transmission of
microbes and
disease is hand
hygiene
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Hand hygiene
1.
2.
3.
Perform hand hygiene:
Before and after patient contact
After removing gloves or any other PPE item
After touching blood, body fluids, secretions, excretions,
and contaminated items, whether or not gloves are worn
After contact with patient surroundings
Routine hand hygiene by alcohol hand rub (preferably) or
by washing hands with soap and water
Perform hand hygiene after touching surgical mask/ N 95
respirator or before touching the face
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DEALING WITH USED GLOVES
1.
3.
When expose to blood, body fluids,
secretions, excretions, mucous
membranes and non-intact skin, and
contaminated items
Perform hand hygiene immediately
after glove removal
2. Change gloves when heavily
contaminated
4. Disposable glove should not be
reused
EPA-REGISTERED DISINFECTANTS OR
DETERGENTS/DISINFECTANTS
• EPA-registered disinfectants or detergents/disinfectants that
best meet the overall needs of the healthcare facility for routine
cleaning and disinfection should be selected . In general, use of
the existing facility detergent/disinfectant according to the
manufacturer’s recommendations for amount, dilution, and
contact time is sufficient to remove pathogens from surfaces of
rooms where colonized or infected individuals were housed.
This includes those pathogens that are resistant to multiple
classes of antimicrobial agents (e.g., C. difficile,
•
VRE, MRSA, MDR-GNB
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COMMON CLEANERS FROM EPA LIST:
•
1. Lysol Brand Deodorizing Disinfectant Cleaner
•
2. Lysol Brand Pre-Moistened Touch-Ups Disinfecting Cleaning Wipes
•
3. Lysol Brand Disinfectant Direct Multi-Purpose Cleaner
•
4. Mr. Clean Multi-Surfaces Antibacterial
•
5. Ultra Clorox Brand Regular Bleach
•
6. Clorox Disinfecting Spray III
•
7. Hydrogen Peroxide
•
8. Pine Oil
•
9. Bio Clean
•
10.Ready-To-Use Bathroom Cleaner and Disinfectant
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HANDWASHING AND HAND HYGIENE • Should be done:
• Before gloving,
• After removing gloves
• After touching blood, body fluids, tissues, secretions,
excretions or any contaminated items. If not visibly soiled can
use alcohol- based but if visibly soiled or contaminated with
proteinacious material use soap and wash hands.
• Between patients
• After procedures on some patients to prevent cross-contamination of
different body sites
• After contact with patients intact skin or inanimate objects near the
patient
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HAND WASHING AND HAND HYGIENE • Wash with soap and water at least 15 seconds when
hands are visibly soiled and follow institutional
procedures
• Use friction
• Can use alcohol-based rubs to decontaminate hand, if
soiled
• Fingernails should be short, clean and free from polish
• Artificial nails should be avoided
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HAND WASHING AND HAND HYGIENE • Rings should not be worn
• Watches and bracelets should be removed
• For alcohol-based rubs, apply to palm of one hand
and rub hand together covering all surfaces of
hand and fingers until hands are dry
• Paper towels should be used to dry hands. Do not
touch faucet handles with hands after washing
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INFECTED PATIENT TRANSPORT WITHIN
INSTITUTION
• If patient has airborne or droplet transmitted infection should
only leave room, if essential
• Patient should wear mask during transport
• Transport personnel should wear appropriate PPE
• Transport route should avoid populated areas
• Receiving personnel should be aware of what PPE and
infection control procedures are needed and when patient is
coming
• Protect stretchers or wheelchairs appropriately
• Appropriate hand hygiene should be used
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TRANSPORT OF SUSPECTED OR CONFIRMED
PATIENT
1.
Limit patient transport unless clinically
indicated
2.
Encourage patients to wear surgical mask if no
contraindication
3. Inform the receiving
service/department of concern
beforehand
4. Clean / disinfect transport vehicles
after use
INFECTED PATIENT TRANSPORT WITHIN
INSTITUTION• Disinfect all transport
equipment and linens
• Patient should be in
clean gown
• Patient should wear or
use appropriate barriers
such as impermeable
dressings for wounds
• Let patients know
how they can assist
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DECONTAMINATION PATIENT CARE ITEMS
1.
Dedicated non-critical patient care items for suspected and confirmed cases
2.
Clean and disinfect reusable equipment before used on other patients.
3.
•
Use 1,000 ppm of hypochlorite solution (i.e. add 1 part of 5.25% hypochlorite in 49
parts of water) to disinfect non-critical items
•
Use 70% alcohol on metallic surfaces
Reusable respiratory equipment should undergo high level disinfection
before reused on other patients
DECONTAMINATION ENVIRONMENTAL CONTROL
Disinfect isolation and procedure rooms after use by a high risk patient
1.
Clean and disinfect the environment regularly and additional
session for frequently touched surfaces
2. Contaminated area should be disinfected by one part of
hypochlorite solution add in 49 parts of water
3. If blood spills occur:
• Use one part of hypochlorite solution add in 49 parts of
water for non-metallic and 70% alcohol for metallic items.
• If spills involve large amount of blood, the blood should be
removed by disposable material soaked with one part of
hypochlorite solution add in 4 parts of water before further
cleaning and disinfection
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PATIENT TEACHING/COUGH ETIQUETTE • Instruction should include cont.:
• Offering masks to persons who are coughing,
• Separating coughing persons at least 3 feet away from others
in a waiting room or have separate locality.
• Instructing patients and providers not to touch eyes, nose, or
mouth.
• Having health care personnel observe droplet precautions
in addition to standard precautions.
• Health care workers should use standard precautions with
all patients.
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PRINCIPLES OF PRECAUTIONS FOR HIGH-RISK
PROCEDURES IN MDRO’S
1. Limit unnecessary procedures
2. Limit extent of procedure
3. Limit number of persons involved
4. Effective decontamination of used items
PRACTICE RATIONALISM OF ANTIBIOTIC
USAGE
• Judicious antibiotic use,
comprehensive surveillance for
targeted MDROs, application of
infection control precautions
during patient care,
environmental measures (e.g.,
cleaning and disinfection of the
patient care environment and
equipment, dedicated singlepatient-use of non-critical
equipment), and decolonization
therapy when appropriate.
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PREVENTION AND TRANSMISSION IS A
COMPLEX PROBLEM
• Preventing the emergence and transmission of
these pathogens requires a comprehensive
approach that includes administrative
involvement and measures (e.g., nurse staffing,
communication systems, performance
improvement processes to ensure adherence to
recommended infection control measures),
education and training of medical and other
healthcare personnel,
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CONTROL OF MDRO’S IS A NATIONAL
PRIORITY
• The prevention and
control of MDROs is a
national priority - one
that requires that all
healthcare facilities and
agencies assume
responsibility and
participate in
community-wide control
programs
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MULTIDRUG RESISTANT STRAINS ARE A GLOBAL
PROBLEM WE ARE ALL CONCERNED
• Antibiotic resistance has both medical and financial costs. It
causes longer and more serious illnesses, lengthening people’s
stays in hospital and complicating their treatment. Sometimes
people die unnecessarily. . At the moment, resistant bacteria
threaten mostly children, the old, cancer patients and the
chronically ill. Nearly 450,000 new cases of multidrug-resistant
tuberculosis are recorded each year; one-third of these people
die from the disease. More than a quarter of new cases of TB
identified recently in parts of Russia were of this troublesome
kind.
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• Programme created by Dr.T.V.Rao MD for
Medical and Health care Workers in the
Developing World
• Email
• doctortvrao@gmail.com
DR.T.V.RAO MD
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